Key result
Sleeve gastrectomy significantly improved liver function capacity at 12 months from baseline (300 to 367 μg/kg/h, p=0.021), whereas Roux-en-Y-gastric bypass did not (306 to 349 μg/kg/h, p=0.45).
Why the study?
The ideal bariatric surgical procedure for NAFLD remains unclear, and inconsistent reports of postoperative liver function deterioration have raised doubt regarding which technique to apply.
Does sleeve gastrectomy improve liver function capacity compared to Roux-en-Y-gastric bypass in patients with obesity?
Cohort (n=175)
No
Does sleeve gastrectomy improve liver function capacity compared to Roux-en-Y-gastric bypass in patients with obesity?
Absolute Event Rate: 367% vs 348.6%
p-value: p=0.485
Sleeve gastrectomy, but not Roux-en-Y-gastric bypass, leads to a significant improvement in liver function capacity at 12 months in patients with obesity.
SG may favor liver function gains over RYGB in obesity; leaves open differential effects pending randomized trials.
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a common condition in patients with obesity. Bariatric surgery has often been proposed as a viable treatment option, but the ideal surgical procedure remains unclear. Inconsistently, reports on postoperative deterioration of liver function put further doubt on which technique to apply. Aim of this study was to assess the impact of Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on the postoperative recovery of liver function. METHODS: A total of 175 patients with obesity that underwent bariatric surgery in our institution were included in this prospective cohort study. BMI, laboratory values, and liver function capacity (using LiMAx) were assessed preoperatively and at 6 and 12 months postoperatively. Generalized linear model (GLM) was performed to determine variables influencing liver function capacity after the operation. RESULTS: Prior to operations, 64% of patients presented with a diminished liver function capacity, as measured by LiMAx test. Liver function capacity significantly recovered after 12 months in the SG group (300 μg/kg/h preop vs. 367 μg/kg/h postop) but not in the RYGB group (306 μg/kg/h preop vs. 349 μg/kg/h). Preoperative factors impeding liver function recovery included type 2 diabetes mellitus (T2DM), weight, male sex, AST/thrombocyte ratio (APRI), and gamma-glutamyltransferase (GGT). CONCLUSION: Bariatric surgery, especially sleeve gastrectomy, leads to an improvement of liver function. However, in some patients with T2DM, higher preoperative weight and male sex postoperative deterioration of liver function capacity may occur.
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Schmitz et al. (2021) conducted a cohort in Obesity and Nonalcoholic fatty liver disease (NAFLD) (n=175). Sleeve gastrectomy vs. Roux-en-Y-gastric bypass was evaluated on Liver function capacity (LiMAx) at 12 months (p=0.485). Sleeve gastrectomy significantly improved liver function capacity at 12 months from baseline (300 to 367 μg/kg/h, p=0.021), whereas Roux-en-Y-gastric bypass did not (306 to 349 μg/kg/h, p=0.45).
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